AA Amyloidosis Treatment — SCE Rheumatology MCQ

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HardConnective Tissue DiseaseAA Amyloidosis TreatmentSCE Rheumatology

A 55-year-old woman with RA and secondary AA amyloidosis presents with nephrotic syndrome (proteinuria 8 g/day). Her SAA (serum amyloid A) is persistently elevated at 85 mg/L despite Methotrexate. What treatment approach is most important?

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Correct answer: E — Aggressive suppression of the inflammatory source (optimise RA disease control with biologic therapy targeting SAA <10 mg/L) to halt amyloid deposition

In AA amyloidosis the most important treatment is suppression of the underlying inflammatory condition to reduce SAA production. A target SAA level <10 mg/L (or ideally <4 mg/L) is associated with stabilisation or regression of amyloid deposits and improved organ function. For RA-associated AA amyloidosis this typically requires escalation to biologic therapy (TNF inhibitors Tocilizumab) which can dramatically reduce SAA. Tocilizumab is particularly effective as IL-6 is the primary driver of hepatic SAA production. The National Amyloidosis Centre recommends serial SAP scintigraphy to monitor amyloid burden.

Reference: Lachmann HJ et al 2007 AA amyloidosis outcomes; Gillmore JD et al 2020 NAC guidelines